Health Care Fraud Schemes: Outpatient Facilities
During this webinar two organizations will explore schemes occurring in the outpatient facility setting. Hear key issues and discuss current scheme data analytics and mechanics.
Part 1 – Misrepresentation of Outpatient Services
In the first half of the webinar, participants will explore how outpatient services can be misrepresented. Examine outpatient levels of care and outpatient “medical clinics” that bill alongside a rehabilitation facility. The speaker will explain data analysis techniques, scheme red flags, and how unbundling, misrepresentation, and fee-forgiving schemes operate.Elizabeth Cyrowski
Senior Investigator
Cigna
Part 2 – Spravato: Investigating Outpatient BH Clinics
Spravato (esketamine) is an intranasal spray used to treat depression. Patients are monitored for at least two hours at each treatment session. Utilization of this medication is rapidly expanding as new clinics are being opened across the country. This session will explore the complexities of investigating these facilities; touching on topics including network exceptions, prior authorization, REMS-certification, and coding.Brian Robinson, CFE, AHFI
Director, Fraud Analytics & Investigations
Point32Health
Joshua Orr, JD
Director of Special Investigations Unit and Senior Associate General Counsel
Point32Health
Registration Information
REGISTRATION RATES
| NHCAA Member1 | Government2 | Non-Member3 |
| $175 | $175 | $250 |
REGISTRATION POLICIES
Registration closes at 3:00 PM ET the day before the webinar.Cancellation/Substitution
All cancellations (regardless of date) will be assessed with at $100 administrative fee. All written notice of cancellations and substitutions should be sent via email to training@nhcaa.org. Cancellations must be received in writing 24 hours in advance of the webinar in order to receive any refund.Complaints
For more information regarding administrative policies such as refunds, cancellations and complaints, please email training@nhcaa.org.Details & Frequently Asked Questions
Webinar programs are most appropriate for beginning and mid-career analysts, investigators, consultants, and law enforcement agents working in the health care anti-fraud industry.
As a level II, or intermediate program, some investigative / health care / coding expertise is assumed. Training content is focused on the detection and investigative processes, using case examples to highlight strategy and techniques.
There are no pre-requisite requirements to attend webinar programs.
Participants earn 1.5 Continuing Professional Education (CPE) hours applicable to the training requirements for the Accredited Health Care Fraud Investigator (AHFI®) designation.
The NHCAA Institute is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: www.nasbaregistry.org.
NASBA Field of Study: Specialized Knowledge & Applications
View our updated FAQ webpage to see if your webinar question has already been answered. If not, email the education team at programs@nhcaa.org.
